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Job Title:Grievance and Appeals Coordinator 1. Must have previous Grievance and Appeals exp. Medical management, Utilization management, and/or running a doctor’s office.
ExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol. Registered Nurse - Care Coordinator is part of an innovative multi-disciplinary care coordination team addressing OHP and CareOregon Advantage members' needs.
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Make appeals complaints and grievance decisions and communicate decision to the claimant within regulatory and accreditation guidelines for timeliness. Analyze, research, resolve and respond to complaints, appeals, and grievances from members, providers, and regulatory agencies with established regulatory and accreditation guidelines.
Full-timeExpandApply NowActive JobUpdated 2 months ago - UpvoteDownvoteShare Job
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The Grievance and Appeals Coordinator will also present cases to the Appeals Committee. The Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare.
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The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance Specialists by handling the administrative functions of the care management/continuity of care process including intake, logging, tracking and status follow-up.
$47,840 - $68,474 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Lead Appeals and Grievance Committee. Position Purpose Analyze and resolve verbal and written claims and authorization grievance/appeals from providers and members.
Full-timeExpandUpdated 16 days ago - UpvoteDownvoteShare Job
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Supervises and manages the Academic grievance and appeals process. Title IX Coordinator: Dr. Devonye C. Brown, Fine Arts Building, Suite C-01 (318) 670-9225: Section 504 Coordinator: Dr. Anjelica Hart, NCR Building, Room 125, (318) 670 -9367.
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Seek to resolve differences in accordance with the scriptural patterns summarized in the Staff Manual policy on Fair Treatment as well as the Grievance and Appeals Procedure. All miscellaneous items found in the facility should be placed in one of the Lost & Found containers located in the lobbies of Barnes and Ashe. All balls left out should be placed in one of the ball cages in Barnes and Ashe gyms.
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Minimum of four years of administrative support experience in a health care organization required Knowledge of DOH and CMS Grievance and Appeals regulatory requirements and procedures for ensuring compliance preferred Proficient PC skills, including MS Excel, Word, and Access required Knowledge of Facets system preferred.
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May coordinate the Grievance and Appeals Committee. 2+ years grievance or appeals, claims or related managed care experience. Prepare response letters for member and provider complaints, grievances and appeals.
Full-timeExpandUpdated 18 days ago - UpvoteDownvoteShare Job
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In some cases may be combined with Grievance Coordinator functions. Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests.
Full-timeRemoteExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Prepares reports on grievance and appeals as required by regulatory agencies, NCQA standards, and Plan management. Maintains appropriate documentation in IDX Customer Service Module to ensure accurate and thorough documentation of appeals/grievance process.
Full-timeRemoteExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Ability to function and excel in a remote environment handling time critical appeals and grievance cases. Handle a large volume of incoming grievance and appeals from receipt through resolution, ensuring that all appeals are resolved within contractual timeframes.
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Responsible for grievance and appeals coordination and resolution for all Samaritan Health Plan (IHN, SAHP, Commercial, Choice) members who engage with the grievance process.
Full-timeExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Grievance and Appeals Coordinator. As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related grievances and appeals across CPHLs various lines of business.
$20.51 - $21.54 an hourFull-timeExpandUpdated 8 days ago
grievance appeals and coordinator jobs
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